My First Night At Home

trevor51590 · Post by **trevor51590** » Thu Jun 11, 2020 6:05 pm

Hello all! First night with my CPAP down. I was diagnosed with Mild/Moderate OSA, with the more moderate typically coming in once I hit REM, although it's fairly well split. I was prescribed 6-8cm auto, and the device was set to a flex of 2. Above are my results, and I've noticed that I have a high amount of central apneas, and the end of my night's sleep seems to be throwing things for a loop. I had 2 CENs on the first night study, and on the second night titration study is when I saw them on the report. As you see here, they remain what I'd consider relatively high. I've done a little bit of research about treatment-emergent central apneas and I'm hopeful that's all it is. I've also heard the flex can play a part in it too. My AHI originally was 14-18.

Really i'm at hypopneas and clear airway events.

Curious to get your opinions on night 1! I've considered taking flex down from 2 to 1 to see if that impacts anything.

Thanks!

Julie · Post by **Julie** » Thu Jun 11, 2020 6:16 pm

What you should do is raise your max pressure setting from 8 (where did that come from?) to 20, as is most usual, and you could try bumping the min. setting to 7.

trevor51590 · Post by **trevor51590** » Thu Jun 11, 2020 6:20 pm

Julie wrote: ↑
Thu Jun 11, 2020 6:16 pm
What you should do is raise your max pressure setting from 8 (where did that come from?) to 20, as is most usual, and you could try bumping the min. setting to 7.

That is how the referral/RX had it set up, which showed me most responsive to 6-8 with 11 appearing to being over-titrated

LSAT · Post by **LSAT** » Thu Jun 11, 2020 7:47 pm

Julie is right...Your 6/8 setting is very inadequate. I would go with her suggestion. The max number of 20 only opens it up so the cpap can go to whatever pressure is needed to stop an event. Currently you are blocking it from going higher than 8. It may never go higher than 10 or 12, but if you want to reduce your AHI...you need to let it run.

Pugsy · Post by **Pugsy** » Thu Jun 11, 2020 7:57 pm

How much of the night did you lay awake with the mask and machine on?
I assume a little bit at the beginning of the night. It would be expected as the first night on the machine. What about that last hour or so after 05:00? I am betting you were awake and the bulk of that last hour flagged events you weren't asleep.
The machine can't tell if you are awake or asleep. All it measures is flow rate of your breathing and awake breathing is very irregular and often the machine will flag those irregularities as some sort of apnea event and it responds that way as well.

It's not easy sleeping with all this going on. I know it took me weeks to get used to it and not have a gazillion wake ups just because of the mask on my face blowing air up my nose.

The pattern of increase when it hits the max of 8 looks very suspicious for it being REM related. Do you know if your OSA is worse in REM or maybe on your back?

If you spent a lot of time during the night awake then I don't know that I would worry so much about the pressure settings at the moment but if you say you slept soundly for the most part then for sure you need more maximum available and possibly a little more minimum but we won't know until we see how well the machine can prevent the apneas when it doesn't have its little hands tied with such a restricted maximum.

So.....how was your sleep in general? Sleep soundly or fragmented with a lot of wake ups and a considerable amount of time spent with mask on and you were awake?

trevor51590 · Post by **trevor51590** » Fri Jun 12, 2020 6:41 am

Pugsy wrote: ↑
Thu Jun 11, 2020 7:57 pm
How much of the night did you lay awake with the mask and machine on?
I assume a little bit at the beginning of the night. It would be expected as the first night on the machine. What about that last hour or so after 05:00? I am betting you were awake and the bulk of that last hour flagged events you weren't asleep.
The machine can't tell if you are awake or asleep. All it measures is flow rate of your breathing and awake breathing is very irregular and often the machine will flag those irregularities as some sort of apnea event and it responds that way as well.

It's not easy sleeping with all this going on. I know it took me weeks to get used to it and not have a gazillion wake ups just because of the mask on my face blowing air up my nose.

The pattern of increase when it hits the max of 8 looks very suspicious for it being REM related. Do you know if your OSA is worse in REM or maybe on your back?

If you spent a lot of time during the night awake then I don't know that I would worry so much about the pressure settings at the moment but if you say you slept soundly for the most part then for sure you need more maximum available and possibly a little more minimum but we won't know until we see how well the machine can prevent the apneas when it doesn't have its little hands tied with such a restricted maximum.

So.....how was your sleep in general? Sleep soundly or fragmented with a lot of wake ups and a considerable amount of time spent with mask on and you were awake?

I had to get to sleep before I saw some of these comments, but I ended up increasing max pressure to 10 and reduced a-flex to 1. This seemed to help the central apenas, when I woke up it felt like it wasn't pushing enough air (not sure if due to a-flex or I should increase pressure)

I did wear it a little bit the first night before bed. The last hour of sleep was me trying to sleep, but it was very light phase. I wasn't fully sleeping.. but I wasn't awake and coherent either. I would say the same applies for this most recent chart below

My OSA is generally higher with REM, where during the sleep study it hit 18AHI or so.

For the most part I am blessed to be able to fall asleep soundly, and stay asleep for the most part. I'm definitely not awake and alert in the middle of the night when it happens. I am not a supine sleeper, but side sleep is a little more difficult for me to do getting used to the headgear, so i've been on my back more. My desats were almost evenly split between side and supine on the study, slightly higher supine. Attached is this past night's report. Thank you all so much thus far!

Pugsy · Post by **Pugsy** » Fri Jun 12, 2020 8:45 am

You are probably going to need a little more minimum pressure to deal with the REM stage sleep events. I think you can clearly see the REM pattern of your clusters. Google sleep stages and make note of when we normally cycle through all the stages for REM.
Fairly easy to spot. I have this myself. My OSA is 5 times worse in REM myself and that's what I had to do to prevent the clusters. The machine needs a better head start to prevent the collapses from happening in the first place. Might be that a small 1.0 cm increase in the minimum will get the job done. Your max of 10 is probably going to be okay as long as you don't ever hit it. The machine won't go anywhere it doesn't think it has a good reason to go. I always just left mine wide open and let the machine sort it out but if you want to limit the max that's fine as long as you never hit it. With a more optimal minimum you might not need to go as high anyway.
The minimum pressure is your most critical setting to optimize.

As far as the centrals ...when you know you were probably not sound asleep just ignore them. They are a reflection of the poor sleep quality and as you learn and adjust to cpap therapy and your sleep quality improves they will reduce. Think of them as false positives and they just don't count in OSA evaluation. An occasional real asleep central apnea is no big deal. It's normal and we all can have them so don't panic when you see occasional random centrals. Centrals aren't a problem unless present in large numbers causing desats or problems bouncing out of sleep.

Some of the centrals you see flagged at the same time as you see OAs flagged are probably arousal related. The OA caused the arousal and the central was a byproduct of the arousal. Do a better job preventing the OAs and the centrals won't happen.
If you want to learn about arousal centrals you can go here and watch the videos and learn to evaluate your own flow rate.
http://freecpapadvice.com/sleepyhead-free-software

trevor51590 · Post by **trevor51590** » Fri Jun 12, 2020 5:47 pm

Pugsy wrote: ↑
Fri Jun 12, 2020 8:45 am
You are probably going to need a little more minimum pressure to deal with the REM stage sleep events. I think you can clearly see the REM pattern of your clusters. Google sleep stages and make note of when we normally cycle through all the stages for REM.
Fairly easy to spot. I have this myself. My OSA is 5 times worse in REM myself and that's what I had to do to prevent the clusters. The machine needs a better head start to prevent the collapses from happening in the first place. Might be that a small 1.0 cm increase in the minimum will get the job done. Your max of 10 is probably going to be okay as long as you don't ever hit it. The machine won't go anywhere it doesn't think it has a good reason to go. I always just left mine wide open and let the machine sort it out but if you want to limit the max that's fine as long as you never hit it. With a more optimal minimum you might not need to go as high anyway.
The minimum pressure is your most critical setting to optimize.

As far as the centrals ...when you know you were probably not sound asleep just ignore them. They are a reflection of the poor sleep quality and as you learn and adjust to cpap therapy and your sleep quality improves they will reduce. Think of them as false positives and they just don't count in OSA evaluation. An occasional real asleep central apnea is no big deal. It's normal and we all can have them so don't panic when you see occasional random centrals. Centrals aren't a problem unless present in large numbers causing desats or problems bouncing out of sleep.

Some of the centrals you see flagged at the same time as you see OAs flagged are probably arousal related. The OA caused the arousal and the central was a byproduct of the arousal. Do a better job preventing the OAs and the centrals won't happen.
If you want to learn about arousal centrals you can go here and watch the videos and learn to evaluate your own flow rate.
http://freecpapadvice.com/sleepyhead-free-software

Thank you very much for the insight! I will increase the minimum pressure to 7 and report back. What is your opinion on Flex? Centrals seemed to go down reducing A-Flex from 2 to 1, and I’m thinking about trying C-Flex or turning it off alltogether

Pugsy · Post by **Pugsy** » Fri Jun 12, 2020 6:07 pm

trevor51590 wrote: ↑
Fri Jun 12, 2020 5:47 pm
What is your opinion on Flex? Centrals seemed to go down reducing A-Flex from 2 to 1, and I’m thinking about trying C-Flex or turning it off alltogether

Flex exhale relief is a personal choice. A comfort feature that sometimes in a small percentage of people find that it is a trigger for central apneas. You are way too early in therapy to make that determination IMHO. Your centrals could very easily simply have been awake events getting flagged by mistake. One/first night on cpap is going to have a lot of wake ups....I know I did.

I personally like exhale relief. I am lucky in that bilevel pressures don't trigger centrals for me. I guess I would deal with it if I had been unlucky enough to have had that happen but I didn't. It's actually a very small subset of people who have this problem.

I don't know that Flex exhale relief was responsible for your centrals. I doubt it. The bulk got flagged when you were awake or half awake and don't really count. Some could simply be related to arousals from OAs.

The difference between CFlex and AFlex isn't going to make any difference IF (big if) your centrals are triggered by flex.
Respironics machines and the Flex relief are actually very limited in terms of the drop during exhale that Flex offers. The most it can ever give you is a 2 cm drop during exhale (at a setting of 3) and that's ONLY if you are a fairly strong breather. The amount of drop during exhale is based more on the force of your own breathing than the setting. It's more of a timing thing really than a drop during exhale. Your change from Flex of 2 to 1...really didn't change things much.

Your choice. Play around with it if you like but I seriously doubt that your central apneas are related to Flex at all.
Pick whatever is the most comfortable way of doing things for you. You have to be comfortable breathing first so you can get to sleep and stay asleep.....without sleep none of this matters.

trevor51590 · Post by **trevor51590** » Sat Jun 13, 2020 3:14 am

Thanks for the reply

Here is night 3. Not a great result, this was with a minimum pressure of 7. It took me longer to fall asleep and didn't feel like good sleep. I may try my DreamWisp mask

trevor51590 · Post by **trevor51590** » Tue Jun 16, 2020 5:57 pm

Following up again with night 6. It appears as I get adjusted to the machine, my sleep is improving. I'm curious if increasing the low pressure may bring the hypopneas down

My First Night At Home

My First Night At Home

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Re: My First Night At Home

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Re: My First Night At Home

Re: My First Night At Home

Re: My First Night At Home

Re: My First Night At Home

Re: My First Night At Home

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